Blood Borne Pathogen Awareness Prevention

Bloodborne Pathogen Awareness And Prevention Bloodborne Pathogen Awareness And Prevention By Richard C. Lavy, M.D. Assistant Director, Coast Guard Support Health and Safety United States Coast Guard Auxiliary Risk Assessment and Management  Identify the hazard  Identify the mission task  Assess the risks  Identify the options  Evaluate the risk VS gain  Execute your decision  Monitor the situation Risk Assessment and Management The Hazard  A substance that may contain a bloodborne pathogen  Blood  Semen  Vaginal secretions  Pus  Amniotic fluid Risk Assessment And Management The Mission  Report of the incident  Arrival on scene  Grossly bloody scene  Airway management  Emergency childbirth  Scene and equipment cleanup Risk Assessment And Management  Tasks and activities that may involve exposure to potentially infectious material  Consider ALL blood and body substances as potentially infectious  Consider ALL persons as potentially infected  Diseased The Risk persons may have NO symptoms Items To Understand (Each Discussed Later)  Modes of exposure and transmission  Epidemiology and symptoms  Exposure control plan  Standard Precautions  Engineering controls  Work practices Items To Understand (cont.) (Each Discussed Later)  Exposure control plan (cont.)  Personal protection equipment Selection Types Decontamination Handling Disposal  Reporting exposures Modes Of Exposure and Transmission  Percutaneous (through the skin) by needle or other sharps  Splash on rash, sore, cut, or scratched skin  Stick  Mucocutaneous (through a mucous membrane)  Splash  Sexual into eyes, nose, or mouth contact Chain Of Infection Modes Of Exposure and Transmission  Infectious agent (virus, bacteria)  Reservoir (infected person)  Means of exit (cut, burn, weeping rash)  Mode of transmission (cleat, screw driver, needle)  Means of entry (puncture wound, rash)  Susceptible host (YOU) Hepatitis B and Hepatitis C  Inflammation of the liver  Million of carriers in U.S.  Incidence in U.S.  Carriers are infectious and may develop serious liver diseases Cirrhosis (scarring of liver) Chronic hepatitis Liver cancer decreasing (2001: 78,000)  HCV: 4 million infected  HBV: Epidemiology Hepatitis B and Hepatitis C Epidemiology (Continued)  Incubation period 45 to 180 days (av.: 60-90 days)  HCV: 14 to 180 days (av.: 42-49 days)  HBV:  HBV:  Acute fatality rate  Premature mortality  HBV: 0.5% - 1.0%  HCV: 4% 15% - 25%  HCV: 20%  Spread as BBP and saliva from a bite Hepatitis B and Hepatitis C Epidemiology (Continued)  Chance of infection after a stick  Survival outside the body 6% to 30% 7 days or longer chain of infection  Immunization HBV: Hepatitis B Immune Globulin HBV: Vaccine available HCV: Vaccine not available  Prevention  Interrupt Hepatitis B and Hepatitis C  Diagnosis  History Epidemiology (Continued) and clinical signs and symptoms  Laboratory tests  Treatment  Supportive (fluids, nourishment)  HBV: Interferon, PEG-INF, Pyrimidine, and Nucleotide analogs.  HCV: Interferon, Ribaviron, PEG-INF (problematic: low effect; high side effects) Human Immunodeficiency Virus (HIV) - Epidemiology  Disease: Acquired Immunodeficiency Syndrome (AIDS)  Incidence: Over 1 million persons infected in U.S. new HIV infections per year in U.S.  25% of infected in U.S. unaware of status  40,000  Spread: mostly via blood, semen, and vaginal secretions HIV - Epidemiology (cont.)  Survival of virus outside body: short  Chance of infection after stick: less than 1%  HIV infection remains incurable  Some viral load persists  Carrier still infectious  Disease transmission higher  Vaccine: not available HIV - Causes for increased incidence  Regulations and separation of counseling and testing from routine medical care  Missed opportunity to diagnose, treat, and stop spread of HIV infection.  Over one-half new HIV infections spread by HIV-positive people unaware they are infected HIV - Causes for increased incidence (cont.)  40% of persons newly diagnosed HIV positive diagnosed concurrently or within one year  Had been infected with HIV for about 10 years  Sicker when treatment started  Died sooner that those whose infection diagnosed early  AIDS Acquired Immunodeficiency Syndrome (AIDS)  Death rate from AIDS not declined since 1998  Newly diagnosed cases of AIDS rising  Onset usually insidious- may not develop for 10 years after infected with HIV  May be prevented by immediate prophylaxis (treatment)  Minutes may be critical AIDS - Diagnosis Clinical findings Signs and Symptoms  Non-specific (mono-like illness)  Swollen lymph glands  Chronic diarrhea  Weight loss  Fever  Tuberculosis suggestive AIDS - Diagnosis (cont.)  Standard disease–control methods  Case  Oral fluid or Blood tests finding and surveillance  Systematic treatment and case management OraQuick Advance Rapid HIV-1/2 Antibody Test: >99% accuracy in 20 minutes* AIDS - Treatment  Drug treatment immediately after exposure may prevent development of AIDS  Minutes may be critical  “Never” cured – a chronic disease for those infected with HIV who receive effective treatment - carriers  Death now no longer inevitable AIDS - Prevention  Interrupt chain of infection  Immediate prophylaxis  Minutes may be critical AIDS Improving Prevention and Treatment  Newly infected people promptly learn of their status  Reduce high-risk behaviors  Begin and continue viral replication suppression treatment when clinically indicated AIDS Improving Prevention and Treatment (cont.)  Distribution and use of condoms and clean needles  Treatment for substance abuse and mental health conditions  Immediate prophylaxis by susceptible contacts Exposure Control Plan Methods Of Compliance  Prevent contact with blood or other potentially infectious materials (Standard Precautions)  ALL body fluids should be considered potentially infectious Exposure Control Plan Engineering Controls  Devices which prevent contact  Gloves,  Other disposable (vinyl or nitrile) personal protection equipment  Isolation and containment supplies  Handwashing facilities  Sharps containers  Medical waste containers Exposure Control Plan Work Practices  Wash hands (even after using gloves)  Do not bend, break, or recap needles (sharps)  Do not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses  Avoid causing splashes or splatters  Properly handle contaminated materials Exposure Control Plan Personal Protection Equipment  Gloves, disposable (vinyl or nitrile)  Gowns or laboratory coats  Face shields or masks  Eye protection  Shoe covers  CPR breathing barriers (e.g., face shields or resuscitation masks)  Resuscitation bags or other ventilation devices Exposure Control Plan Personal Protection Equipment (cont.)  Must be readily accessible  Kits  Gloves In  Hypoallergenic gloves used because of increasing incidence of latex allergy personal flotation device (PFD) In film canister in PFD Exposure Control Plan Personal Protection Equipment (cont.)  Cleaning, laundering, and disposing (hospital)  Replace  If defective (inspect regularly)  Immediately after use  Different patient  Disposable Exposure Control Plan Housekeeping  Maintain worksite in clean and sanitary condition  Determine & implement cleaning schedule  Determine method of decontamination 1:10 dilution fresh household bleach (sodium hypochlorite) solution and let stand for > 10 minutes Exposure Control Plan Housekeeping (cont.)  Clean all equipment & surfaces after contamination occurs (deck, cleats, chafing gear, survival equipment)  Use personal protective equipment  Inspect bins, pails, cans, & similar receptacles – never insert hands  Broken glassware (use mechanical means)  Clean up as soon as possible  Use disposable gloves and more Exposure Control Plan Cleaning Up Spilled Blood personal protective equipment as indicated  Wipe up with paper towel or other absorbent material  Flood area with 1:10 fresh bleach solution and let stand for > 10 minutes  Dispose of contaminated materials in a labeled biohazard container Exposure Control Plan Laundry  Handle contaminated laundry as little as possible using Standard Precautions  Bag contaminated laundry & place in appropriate container  Labeled biohazard  Color coded Fluorescent orange Orange-red Exposure Control Plan Laundry (cont.)  Laundry (per local protocol)  Approved laundry facility  Use CDCP or manufacturer’s recommendations  Detergent  71 degrees Celsius (170 degrees Fahrenheit) 25 minutes If Not Adequately Equipped  Leave the area  Notify controlling authority Personal Protection Equipment Donning (See Appendix for technique) Gloves - Used alone when minimal risk of exposure exists Personal Protection Equipment Donning (See Appendix for technique) Use extensive protection when greater risk of exposure exists  Mask and eye protection  Gown  Shoe covers  Gloves Personal Protection Equipment Make Sure Contaminated Apparel Does Not Come Into Contact With Clothing or Skin Personal Protection Equipment  Do not cross contaminate  Use different gloves and other PPE when treating another patient Personal Protection Equipment Removing Carefully (See Appendix for technique)  Shoe covers  Gown /gloves  Gloves  Head cover  Mask and eye shield Biohazard Waste Bag  Able to be closed  Leakproof  Labeled and/or color coded  Do not contaminate outside of bag  Secure opening by knotting Personal Protection Equipment Disposing  State regulations  Civilian emergency medical responders  Local hospital Hand Washing  After ANY contact (even if gloves have been worn)  Lather with soap  Vigorous rubbing of all surfaces  15 seconds minimum Hand Washing (cont.)  Antiseptic towelette  Wipe all surfaces  Dispose of in trash  Wash when facilities available If Contaminated Or Punctured Post-exposure  Decontaminate  Evaluation and follow-up if ANY exposure  Prophylaxis: DO NOT DELAY Minutes may be critical If Contaminated Or Punctured Decontamination  Flood the exposed body area with water and clean any wound with soap and water or a skin disinfectant if available  Document circumstances of exposure  Source  Intensity  Duration of exposure  Route If Contaminated Or Punctured (Cont.)  Report incident immediately to controlling authority or operational commander  Seek immediate medical attention  Remember: Minutes may be critical Reports  Radio  Written  Medical information  Exposure  Extent  Duration  Breakdown in protection  Care rendered Summary  Are you trained?  Are you equipped?  If “no” Notify station Do not become a victim Summary (cont.)  If “yes” Respond Monitor the situation Inform station of all activities Record all that transpires Activate appropriate resources Appendix Techniques for Donning and Removing Personal Protection Equipment Personal Protection Equipment (PPE) Donning and Removing The following slides describe techniques for donning and removing BBP Personal Protection Equipment. PPE - Donning Gloves (Used alone when minimal risk of exposure exists)  Remove jewelry  Insert hands  Pull upward from cuff  Pull glove over garment cuff PPE - Donning The following directions are for donning the contents of a complete Personal Protection Equipment kit when a high risk of exposure exists. PPE - Donning Mask and Eye Protection  Open mask/visor by gripping top and bottom and opening pleated area  Place ear loops over each ear  Pull bottom of mask under chin  Bend nosepiece to conform over nose PPE - Donning Mask and Eye Protection (cont.) PPE - Donning Gown  Slide arms into gown  Tie strings in shoelace bow PPE - Donning Shoe Covers  Insert entire shoe until covered and snug  Be very careful to avoid slipping PPE - Donning Gloves  Remove jewelry  Insert hand  Pull glove upward from cuff  Pull glove over garment cuff Personal Protection Equipment Removing The following slides describe the techniques for removing BBP Personal Protection Equipment. PPE - Removing Gloves (When used alone)  With right hand, grasp left glove 2 inches below cuff  Partially remove left glove by inverting it until only prior inside is visible PPE - Removing Gloves (When used alone, cont.)  With partially gloved left hand, grasp right glove 2 inches below the cuff edge  Partially invert right glove until only fingers are visible PPE - Removing Gloves (When used alone, cont.)  With fingers of right hand, hold and remove left glove, encasing it in right glove  Grasp inside of right glove with fingers of left hand and remove right glove PPE - Removing Gloves (When used alone, cont.) Dispose of gloves in biohazard waste bag PPE - Removing (When a complete PPE kit has been used)  Remove Carefully  Deposit each component in biohazard waste bag  First: Shoe Covers PPE - Removing Gown/Gloves With right hand, firmly grasp left wrist area of glove and gown PPE - Removing Gown/Gloves (cont.)  Withdraw left hand  Slide left arm out of gown  Untie tie-strings with left hand PPE - Removing Gown/Gloves (cont.) With left hand, grasp inside of right shoulder of gown and remove, turning right sleeve inside out to wrist PPE - Removing Gown/Gloves (cont.) With left hand, grasp inside right wrist area of glove and gown and remove right hand PPE - Removing Gown/Gloves (cont.)  Roll gown carefully, touching only clean, inside surface  Deposit in biohazard bag PPE - Removing Mask and Eye Protection  Remove after all other clothing  Grasp earloops or untie strings with both hands PPE - Removing Mask and Eye Protection (cont.) Deposit in biohazard bag Personal Protection Equipment Make sure contaminated apparel does not come into contact with clothing or skin Dispose of properly References COMDTINST M6220.8 “Prevention of Bloodborne Pathogen Transmission” U.S. Coast Guard Medical Manual M 6000.1C Chapter 13, Section J U.S. Department of Labor Occupational Safety & Health Administration Regulations (Standards - 29 CFR) Bloodborne pathogens. - 1910.1030 *Department of Health and Human Services Centers for Disease Control & Prevention Updated: April 1, 2005 Bloodborne Pathogen Awareness and Prevention Edition: 31 May 2007